Articles on Radiofrequency Ablation

[Milligan-Morgan hemorrhoidectomy with a radiofrequency scalpel]

Filingeri V, Rosati R, Gravante G, Pietrasanta D, Fiorito R, Casciani CU.Chirurgia Generale, Universita Tor Vergata, Rome, Italy. v.filingeri@tiscali.it

Minerva Chir. 2003 Jun; 58(3): 355-9. [Article in Italian]

BACKGROUND: Postoperative pain has always been the main adverse effect of surgical treatment for hemorrhoids. Therefore, surgical techniques evolved mainly to solve this problem and, secondly, postoperative bleeding, recurrences and stenosis. METHODS: Two homogeneous groups of 20 patients each were investigated. Both of them were affected by fourth grade hemorrhoidal prolapse and were homogeneous for age, sex and presentation symptoms. Patients previously treated for other proctologic diseases were excluded. A group was treated with standard Milligan-Morgan hemorrhoidectomy and the other with radiofrequency scissors. Every patient underwent a follow-up protocol based on outpatient visits at 15, 30, 45 postoperative days and 3, 6 and 12 months. RESULTS: The results show a substantial similarity between these techniques. However, radiofrequency scissors further improved the simplicity of the technique and the postoperative adverse effects. In particular, the procedure lasted 7 minutes less with radiofrequency scissors. Patients treated with the radiofrequency technique had their first postoperative evacuation 24 hours before the standard technique and reduced the mean postoperative hospital stay at 2.5 days (4.5 days in the standard group). The incidence of postoperative pain was reduced in patients treated with radiofrequency scalpel and the follow-up controls in both groups didn't show any complication as stenosis or incontinence. CONCLUSIONS: The radiofrequency-performed Milligan-Morgan hemorrhoidectomy is a valuable technique that improves the classical difficulties in execution, reducing the length of hospital stay and the incidence of postoperative pain or other complications.

Radiofrequency ablation and plication of hemorrhoids.

Gupta PJ.

Fine Morning Hospital and Research Center, D/9, Laxminagar, Nagpur 440022, India. drpjg@yahoo.co.in

Tech Coloproctol. 2003 Apr; 7(1): 45-50; discussion 50.

BACKGROUND: Radiofrequency ablation is emerging as a new therapeutic method in various fields of medicine. This study describes procedure of radiofrequency ablation followed by plication of hemorrhoidal mass in advanced grades of hemorrhoids. METHODS: This non-controlled, prospective study included 300 patients (211 men) treated at Fine Morning Hospital, Laxminagar, Nagpur, India, between July 1999 and December 2000. Patients were followed over a median period of 18 months (range, 15-20 months). RESULTS: The hospital stay was less than 24 hours for all patients. After 1 week, most of the patients had symptoms like bleeding and pain. At 4 weeks, 21% complained of pruritus, but none had prolapse, incontinence or anal stenosis. At the last follow-up, 96% had relief from bleeding, while 8% of patients had developed external skin tags and 6% had asymptomatic recurrence revealed by anoscopy. CONCLUSIONS: For advanced degree of piles with prolapse as the main symptom, plication of the pile mass along with radiofrequency ablation may be used as an alternative to the various types of hemorrhoidectomies. With this treatment, hospital stay is minimized, postoperative pain in low, recurrence is low and return to work is faster.

Sphincterotomy with radio frequency surgery: a new treatment technique of fissure in ano and associated pathologies.

Gupta PJ.

Gupta Nursing Home, D/9 Laxminagar, Nagpur-440022, India.

Rom J Gastroenterol. 2003 Mar; 12(1): 37-40.

BACKGROUND: Anal fissures are dealt with using traditional approaches aiming at relieving the anal spasm and minimizing the anal sphincter pressure. Nevertheless, pathologies like sentinel tags, anal papillae, anal polyps, or small hemorrhoids which are often associated with chronic fissures are either considered innocuous, therefore left untreated, or are removed by conventional techniques. MATERIAL AND METHODS: In this retrospective, non-randomized study, we performed lateral internal sphincterotomy, which was followed by radio frequency surgical procedures to eliminate the associated pathologies mentioned above. RESULTS: In all, 283 patients were studied. All the patients treated by the method of lateral subcutaneous internal sphincterotomy followed by radio frequency surgical procedure for aforesaid associated pathologies were made comfortable on account of the reduction in pain and irritation during defecation, the pricking or foreign body sensation in the anus and pruritus or wetness around the anal verge. A follow up after 18 months showed that only 7 % of patients had recurrence of symptoms or local signs. CONCLUSION: This combined approach has been found to be an effective, easy and quick way of treating chronic fissure in ano with associated pathologies

Novel technique: radiofrequency coagulation--a treatment alternative for early-stage hemorrhoids.

Gupta PJ.

Gupta Nursing Home, Nagpur, India.

MedGenMed. 2002 Jul 31; 4(3): 1.

BACKGROUND: For early-stage hemorrhoids, in which bleeding is the primary symptom, conventional approaches to management include injection of sclerosing solutions, band ligation, and infrared coagulation. In our study, we used the radiofrequency coagulation technique as an alternative strategy to treat early-stage hemorrhoids. MATERIALS AND METHODS: A total of 210 patients with bleeding hemorrhoids were treated with radiofrequency coagulation at the Gupta Nursing Home in Nagpur, India. RESULTS: Follow-up was at 2 weeks, 3 months, and 12 months after procedure. Results were recorded as follows: (1) Bleeding--Twenty-eight (13%) patients had recurrence of bleeding during the observation period. (2) Pain--Some degree of discomfort was reported by all patients within the first 48 hours. (3) Retention of urine--Only 1 patient had retention of urine; this patient was 74 years old and had an enlarged prostate. (4) Discharge--Thirty-four (16%) patients complained of discharge in the first 2 weeks after procedure. (5) Return to work--Seventy percent (n = 145) of patients resumed their duties after 48 hours; the remainder required 1 additional day. (6) Sepsis--There were no reports of postprocedure sepsis. (7) Sphincter function--None of the patients experienced problems with continence or stenosis. Overall patient satisfaction was 84% (n = 177). CONCLUSION: Although these initial results of coagulation of hemorrhoids by radiofrequency appear quite exciting and encouraging, long-term follow-up is needed to assess the duration of relief and potential side effects. Continued work in this area will likely provide promising new dimensions in the effective management of early-stage hemorrhoids in which bleeding is the main symptom. A separate, randomized trial was carried out to assess the difference in efficacy between infrared coagulation and radiofrequency coagulation in 100 patients with early-stage hemorrhoids. Radiofrequency coagulation was found to be more effective than infrared coagulation in terms of recurrence of bleeding, asymptomatic recurrences of hemorrhoids, and overall satisfaction of technique.